Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA.
Infectious Diseases Section, University of Pittsburgh and VA Pittsburgh Healthcare System, Pittsburgh, PA.
Transplantation. 2018 Nov;102(11):1815-1823. doi: 10.1097/TP.0000000000002353.
Invasive aspergillosis and mucormycosis are life-threatening infections in solid organ and hematopoietic cell transplant recipients. Despite medical advancements in the care of these patients and the availability of new mold-active drugs, the outcomes remain suboptimal. Therefore, there has been increased interest in the use of combination antifungal therapy, in hopes that leveraging the possible in vitro synergy of these agents will improve the prognosis of invasive mold disease. However, there has been a large disconnect between the results of experimental and clinical investigations, as clinical studies have not unequivocally demonstrated the superiority of combination therapy over monotherapy. This is particularly true for mucormycosis, where the rarity of the condition has made it nearly impossible to prospectively study novel therapeutic strategies. We review the current standard of antifungal therapy and the preclinical and clinical data addressing the merit of combination therapy, and we provide guidance to optimize the management of these mycoses.
侵袭性曲霉病和毛霉病是实体器官和造血细胞移植受者面临的危及生命的感染。尽管在这些患者的治疗方面取得了医学进展，并且有新型抗真菌药物可用，但结果仍不理想。因此，人们越来越关注联合抗真菌治疗的应用，希望利用这些药物可能的体外协同作用来改善侵袭性霉菌病的预后。然而，实验和临床研究的结果之间存在很大的脱节，因为临床研究并没有明确证明联合治疗优于单药治疗。毛霉病尤其如此，这种疾病的罕见性使得几乎不可能前瞻性地研究新的治疗策略。我们回顾了目前的抗真菌治疗标准以及涉及联合治疗优势的临床前和临床数据，并为优化这些真菌感染的管理提供了指导。
